Risks and benefits of grommets

Overview

Grommets are tiny tubes, about the size of a grain of rice, that a surgeon places in a child's eardrum. They help drain fluid from the middle ear and let air in. This can improve hearing and reduce ear infections.

Yes, grommet surgery is one of the most common operations in children. Many children have them at some point.

Most often children between the ages of 1 and 3 with persistent 'glue ear' (fluid in the ear) or frequent ear infections. It is less common in older children and adults.

Symptoms

Common symptoms

• Hearing loss or muffled hearing
• Feeling of fullness or pressure in the ear
• Trouble understanding speech, especially in noisy places
• Ear pain or pulling at the ears (especially in young children)

Symptoms in children

• Pulling or tugging at one or both ears
• Not responding to quiet sounds, or turning up the TV volume
• Delayed speech or language development
• Balance problems or clumsiness
• Frequent ear infections with fever and irritability

Symptoms in older adults

• Hearing loss that comes and goes
• A feeling of liquid moving inside the ear
• Less frequent ear infections, but more persistent fluid

Causes

Main causes

• Glue ear, which is thick fluid building up behind the eardrum because the Eustachian tube (the small tube that connects the ear to the throat) is not working properly.
• Repeated ear infections that cause fluid to stay in the ear.

Risk factors

• Being between 1 and 3 years old, because the Eustachian tubes are shorter and more horizontal
• Attending daycare or being around many other children
• Bottle feeding instead of breastfeeding (breastfeeding seems to protect against ear infections)
• Exposure to cigarette smoke
• Allergies or a family history of ear problems

When to see a doctor

See a doctor urgently if:

• If your child has a high fever with ear pain that does not improve with pain relievers
• If you notice sudden hearing loss in any family member

Book a routine appointment if:

• If your child has had hearing problems for more than 3 months, such as not responding to sounds or speech delay
• If an ear infection happens 4 or more times in 6 months

Diagnosis

A doctor will look inside the ear with a special light (otoscope) and may do other tests to check how the ear is working.

Tests that may be done

• Otoscopy: Using a small tool with a light to see the eardrum and look for fluid or infection
• Tympanometry: A quick, painless test that measures how the eardrum moves when air is blown into the ear
• Hearing test (audiometry): To check if your child hears sounds at normal levels

What to expect at your appointment

The tests are straightforward and painless. For young children, the hearing test may be done as a game, like turning their head toward a sound. If glue ear is found, your doctor will discuss whether watchful waiting or grommets might help.

Treatment

Treatment often starts with watchful waiting because many cases of glue ear get better without surgery. If problems last more than 3 months or cause significant hearing loss, grommets may be offered.

Self-care at home

• Avoid exposing your child to cigarette smoke
• Manage allergies if they are a trigger
• Use pain relievers (like paracetamol or ibuprofen) for ear pain, but follow the dose on the packet and ask your pharmacist or doctor for advice
• Keep the ears dry when swimming or bathing (use earplugs or a shower cap)

Medical treatments

If glue ear does not clear on its own, surgery to insert grommets is the main treatment. The operation is done under general anesthesia and takes about 15 minutes. The surgeon makes a tiny cut in the eardrum, removes any fluid, and places the grommet. Hearing often improves right away.

When is surgery considered?

Surgery is usually recommended when glue ear has lasted more than 3 months and caused hearing loss, or when a child has had many ear infections that do not respond to other treatments.

Living with this condition

After grommet surgery, most children feel better quickly. Keep water out of the ears for the first few weeks to prevent infection. After that, many doctors say children can swim with earplugs or a swim cap, but it is best to ask your surgeon.

Lifestyle tips

• Your child can go back to normal activities a day or two after surgery
• Avoid blowing air into the ears, like from strong nose blowing or flying in an airplane, until the doctor says it is safe
• Watch for any signs of infection, such as pain, discharge, or fever

Diet and exercise

No special diet is needed. Encourage a healthy, balanced diet to support overall health. Exercise is fine as soon as your child feels ready.

Mental health and emotional wellbeing

Living with hearing problems can be frustrating for children, especially if they have trouble at school or with friends. Grommets often improve hearing and social confidence. If your child feels upset about the surgery or about their ears, talk to your doctor or a child psychologist.

Prevention

Not completely, but you can lower the risk by breastfeeding (if possible), keeping your child away from cigarette smoke, avoiding bottle feeding lying down, and making sure your child gets recommended vaccinations.

Vaccines

The pneumococcal vaccine and the flu vaccine may help reduce the chance of ear infections. Ask your doctor about the vaccination schedule.

Screening programmes

There is no routine screening for glue ear. If you notice hearing problems, see your doctor.

Complications

If left untreated

• Long-term hearing loss that can affect speech and language development
• Repeated ear infections that may lead to a hole in the eardrum
• Learning difficulties or problems with attention in school

Long-term outlook

For most children, grommets are a safe and effective way to improve hearing and reduce ear infections. They usually fall out on their own, and many children outgrow the need for them. With proper care, the outlook is excellent.

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